【摘要】 目的比较彩色多普勒超声(CDU)及计算机断层扫描血管造影(CTA)在术前下肢穿支血管特征评估、穿支皮瓣设计中的应用效果。方法自2017年1月至2020年12月,纳入下肢软组织缺损修复患者50例,采用CDU和MDCT术前探测下肢穿支血管位置、口径、走行等信息,并加以比较评估,选择优势穿支指导皮瓣设计。术中对检测结果进行验证。结果在大腿区域穿支血管识别率CTA 100%,CDU 94.1%;在小腿区域,则是CDU 96.9%,CTA 87.9%。CDU表现出更好的下肢穿支血管定位准确率。术后所有皮瓣均成活,有2例皮瓣远端出现表皮坏死,经换药后愈合。供区44例直接关闭缝合,6例行部分植皮关闭。结论穿支血管术前影像学导航技术可提供穿支血管位置、口径、走行等信息,以指导手术设计,缩短手术时间,提高手术效果。对于下肢脂肪层厚的部位建议行CTA,脂肪层较薄的部位建议行CDU。更多还原

【Abstract】 Objective To compare the clinical effects of preoperative perforator evaluation and flap design in lower extremity with color Doppler ultrasound( CDU) and computed tomography angiography( CTA). Methods From January 2017 to December 2020,50 patients who underwent reconstruction with perforator flaps in lower extremities were treated. The position,caliber and route of the perforator were explored by CDU and CTA preoperatively. The result of the preoperative navigation with both techniques assisted the selection of the dominant perforator and the flap design and were verified during the operation.Results CTA had a higher accuracy of identification than CDU in thigh( 100% vs 94. 1%),but lower in calf( 87. 9% vs 96. 9%). CDU had a higher accuracy of location of the perforators in lower extremity( 96% vs 92%). All the flaps survived.There were 2 flaps that presented with distal necrosis which healed by regular dressing change. The donor sites were closed directly in 44 cases,while partial skin grafting were performed in 6 cases. Conclusion Preoperative imaging techniques can offer anatomic characters of perforator vessels,include position,caliber and route,which make flap design more convenient,shorten the operative time,and improve the surgical result. CTA is recommended for the thick fat layer of lower extremities,and CDU is recommended for the thin fat layer of lower extremities.更多还原